Triglycerides: The Good, The Bad, And The Ugly - Unraveling The Truth About Fats

Are all fats created equal? In this video, we'll unpack the myths and realities surrounding these crucial molecules. Discover how they can fuel your body or put your health at risk. From the fats that safeguard your heart to those that lurk with hidden dangers, get ready to learn which triglycerides are heroes in disguise and which are villains in your diet. Tune in, transform your health knowledge, and take control of your well-being!

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Transcript

Dr. Michael Lam: 0:00

Lipid panel is a commonly prescribed test when you go to visit your doctor to check how your risk for cardiovascular disease and it consists of HDL, LDL, triglyceride, and total cholesterol. And these are numbers that you get. HDL is called the good cholesterol. LDL is called so called a bad cholesterol. And triglyceride is a type of fat. And you get if you combine those three together, you get a total cholesterol. Total cholesterol is a calculated number in the formula is total cholesterol is equal to HDL plus LDL plus triglycerides divided by five. So if your HDL the good cholesterol is good, then your total cholesterol is going to be up. If your LDL is high, then your total cholesterol is also up. Same thing with triglycerides. What we do know is that there are two types of LDL one is called an ApoA particle which is what we call a fluffy LDL particle. And this consists about 80% of have it in our bloodstream. And then there's another kind which is called ApoB LDL particle, which is the cardiovascularly negative that means as compared to the ApoA which is cardiac neutral, it doesn't it's not good or not bad LDL B particle or ApoB particle is more attends and is lacking in the triglyceride and therefore it can have a smaller particle and can it be sticky. And as a result, it goes into the blood vessel and can cause atherosclerosis and inflammation in the endovascular walls. Okay. So that is the thing that we seldom that we talked about triglyceride, because for many, many years, we don't quite understand the mechanism of how triglyceride works. And so And of course, when people get high triglyceride, there's not a lot of medication to bring it down. So as a result is kind of overlooked until recently, the wide the use of statins, for example, to lower LDL has really produced very, I would say at best mixed results over the years in big trials and meta studies, which has shown that a view the prolong of life is really not that significant. So there may be other factors involved that is pointing us to cardiovascular health, and triglyceride over the last 10 years or so has come into the forefront as something that we seldom understand. So first of all, let's take a step back and understand how triglycerides made. You know, when you eat something, especially carbohydrates, such as refined sugar, as well as starch, which is really a sugar linked together, it goes into your bloodstream, goes to your stomach, and then is quickly absorbed and is digested by the cells and your blood sugar will rise. So when the blood sugar rise, the insulin will come up from the pancreas to do with bring it back down so that you don't want to have a high sugar in your bloodstream all the time. This high insulin will bring the sugar from outside the cells or outside the liver into storage when it's excessive amount, because excessive amount of sugar circulating in the blood is not good. So the body has an automatic mechanism to bring it into the liver and the sugar. The insulin is such a messenger, okay, so it carries the package from the post office to your home. And the package is the sugar, the carbohydrates. And once it's in the liver, this is called excess sugar or glucose that is not being used by the cells. It is then stored as glycogen. Glycogen is a short term form of energy storage and is stored in the liver and glycogen lasts about six to eight hours. And that's what you rely upon between meals. Excess amount of that is turned into a fat call triglyceride. And this is what is being measured in the blood. Now triglyceride will stay in the liver for a while is packaged in what was called VLDL. An excess amount is then kind of pushed back out of the liver in these balloons or taxis called VLDL. Or very low density lipoproteins and then it's carried to a peripheral tissue where it's then deposited for burning as well as for storage. So that's why if you have a lot of carbohydrates in your diet, your triglycerides will go up and your VLDL if you measure in Blood will also go up in high triglycerides in the peripheral tissue leads to increase in weight gain increase in peripheral fat. So you gain weight. And of course, those are the key indicators. Now, at the same time, the triglycerides, some of it is deposited back into the liver because the liver is an organ is immediately close to the triglyceride. So there's some storage, excess amount of triglyceride right then stored in the liver and the liver become fatty. And that's why you have fatty liver when you do a CT scan, for example, over 40% of American population has non alcoholic fatty liver. And it's not because they take alcohol which we said earlier is non alcoholic, but it's because of a carbohydrate. In particular, fruits are particularly problematic because fruit, a sugar is called fructose. And fructose is brought into the liver for digestion and metabolism, because that's where it is metabolized. And therefore, high fructose means high workload for the liver. So no triglyceride. Also, if you have too much has what we call a spillover effect, not only from VLDL, but some gonna leak through back into the bloodstream and causes the body to recognize that and you have a little bit more triglycerides in the blood as well as when the triglyceride is being kind of offloaded in by the VLDL, somewhere spills back into blood. So you have increasing weight increase in fat, increasing the VLDL. And you can also lead to increase the LDL in the form of the ApoB particle type in which more importantly, which has been overlooked is a triglyceride. High in the liver means the liver is kind of jammed up, it doesn't want to receive any packages like the warehouse that is already full. So sending more FedEx package and the Post Office package is going to be rejected, in which case the body sends a signal to reject the insulin and insulin resistance development. What does that mean? That means that the body, the liver is telling the insulin I said, I don't want to comply anymore. So even though the if the more carbs you eat, the more insulin is released, the effectiveness of the insulin bringing the sugar into the liver is reduced. As a result, your sugar level in your bloodstream goes up. And when you measure you have what we call hyperglycemia. Your A1C keep rising from a normal of under 5.5 to 5.8, for example, into pre diabetic range of 6.2 and ultimately to diabetic type two. If this we're not I'm a type one, okay with adult onset diabetes, which is a high amount of sugar in your blood. And that's classically how adult onset diabetes is defined. This is different from type one diabetes, which is an absolute deficiency in insulin. So type two, which is what most adults have in this pandemic in the world. So to say, it's due to too much sugar in the blood which comes from too much triglyceride. And as a result, triglyceride comes from carbohydrates. And if you want to reduce your blood sugar, very effectively, the first thing you have to do is check your triglycerides, if your triglyceride over HDL ratio is over 2.5, or if the triglyceride divided by LDL ratio is more than 1.5. Or if your fasting insulin is over 15, that is equivalent to insulin resistance and is an alert for high triglyceride on top if you're worried about fatty liver, your triglyceride fasting triglycerides will be a good indicator. And if you don't have access to that do a liver enzyme called Al T, which in a fasting state will give you a good indication. So the culprit in diabetes is not insulin not having enough. Unfortunately, most of the time now, we think of insulin as a diabetic deficiency hormone so we give insulin. The reality is that diabetes in adult, is excessive amount of triglyceride, causing the bodies in the pancreas in particular, to release more insulin but more insulin is no use because the body is being rejected, leading to insulin resistance. triglyceride is ultimately therefore the part that we have to look forward to studying the total cholesterol is really very little meaning other than just giving you a very rough estimate of what is really going on to bring down your triglycerides and then you're going to be a happy camper. And the good news is that triglyceride can come down very quickly over 30-60 days period, you can have a drastic reduction of 50 to 100 points sometimes that depends on where you start this and also you will lose some weight. Okay. Now, we will go into a separate issue in terms of how to use a diet to reduce the triglyceride, because ultimately, triglyceride is a indicator of diabetes and triglyceride is a dietary illness is not a hormonal illness. So we have to focus on that. I hope this video has been helpful in your understanding of the critical part triglyceride plays in our daily living and lipid metabolism.